Provider Demographics
NPI:1518952092
Name:NIDO LANAUSSE, ROQUE CESAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROQUE
Middle Name:CESAR
Last Name:NIDO LANAUSSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-0180
Mailing Address - Country:US
Mailing Address - Phone:787-864-1012
Mailing Address - Fax:787-866-2125
Practice Address - Street 1:3 CALLEJON LOS VETERANOS
Practice Address - Street 2:GUAYAMA MEDICAL CENTER, 1ST FLOOR
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-5984
Practice Address - Country:US
Practice Address - Phone:787-864-1012
Practice Address - Fax:787-866-2125
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7453208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3307453OtherUIA
PR600564OtherMMM
PR1173OtherINTERNATIONAL MEDICAL CAR
PRPE-1451OtherPALIC PROVIDER
PR6550006OtherHUMANA
PR066139OtherCRUZ AZUL
PR2-04001OtherPREFERRED
PRM-115OtherMENONITA
PR99248NIOtherSSS
PRPE-1451OtherPALIC PROVIDER
PR29085Medicare ID - Type Unspecified